Varicose Veins: Evaluating Modern Treatments, With Emphasis on Powered Phlebectomy for Branch Varicosities

Frank Vandy; Thomas W Wakefield


Interv Cardiol. 2012;4(5):527-536. 

In This Article

Future Perspective

The future direction of TIPP is unknown. The paucity of supportive data and lack of widespread use have limited its solidification as a tool in the armamentarium against venous disease. Current evidence does not offer a superior benefit of TIPP over stab phlebectomy. Still, after surmounting the learning curve, the use of TIPP is definitely not harmful and, anecdotally, may serve its best purpose in removing large extensive clusters of varicosities. Advances and modifications in TIPP over the past decade have created a more refined and precise procedure and with the recent introduction of the 4.5 mm serrated head, there is no reason to suspect the technology will not continue to improve. In order for TIPP to thrive, comparative trials are necessary. It is already known that TIPP decreases the number of necessary incisions, but does this matter clinically or economically? Does the decreased procedure time equate into an economic advantage? Do the paresthesias with TIPP occur at a greater frequency or severity that with stab phlebectomy? Furthermore, are such paresthesias even a clinical consequence? All of these queries need to be examined before judgment can be passed on the future of TIPP. However, in experienced hands, the benefits of TIPP allow the patient to experience a quicker procedure with fewer incisions and given the use of subcutaneous transillumination, a decrease in missed varicosities. Although office-based TIPP is in its infancy, early results look promising. As with all emerging technologies, the key to success is careful patient selection as well as patience in learning and understanding a new technique. If these simple principles are adhered to, incorporating TIPP into the algorithm for treatment of varicose veins, especially large clusters, is a possibility for all venous surgeons.